Abstract - Janeiro a Julho de 2019

A fNIRS Investigation of Speech Planning and Execution in Adults Who Stutter - NEUROCIÊNCIAS

Neuroscience. 2019 May 15; 406:73-85. Epub 2019 Mar 6.

Jackson ES, Wijeakumar S, Beal DS, Brown B, Zebrowski P, Spencer JP.

New York University, New York, NY, University of Stirling, Stirling, Scotland, UK; Holland Bloorview Kids Rehabilitation Hospital, Ontario; University of Toronto, Toronto, ON; University of Wisconsin-Eau Claire, WI; Wendell Johnson Speech and Hearing Center, Iowa City, Iowa; University of East Anglia, Norwich, UK.

Our study aimed to determine the neural correlates of speech planning and execution in adults who stutter (AWS). Fifteen AWS and 15 controls (CON) completed two tasks that either manipulated speech planning or execution processing loads. Functional near-infrared spectroscopy (fNIRS) was used to measure changes in blood flow concentrations during each task, thus providing an indirect measure of neural activity. An image-based reconstruction technique was used to analyze the results and facilitate their interpretation in the context of previous functional neuroimaging studies of AWS that used positron emission tomography (PET) or functional magnetic resonance imaging (fMRI). For planning, we compared neural activity associated with high versus low planning load in AWS and CON. For execution, we compared the neural activity associated with overt versus covert naming in AWS and CON. Broadly, group level effects corroborate previous PET/fMRI findings including under-activation in left-hemisphere perisylvian speech-language networks and over-activation in right-hemisphere homologues. Increased planning load revealed atypical left-hemisphere activation in AWS, whereas increased execution load yielded atypical right fronto-temporo-parietal and bilateral motor activation in AWS. Our results add to the limited literature differentiating speech planning versus execution processes in AWS.

PMID: 30851356 DOI: 10.1016/j.neuroscience.2019.02.032

A Novel Stuttering Disfluency Classification System Based on Respiratory Biosignals - AVALIAÇÃO

Conf Proc IEEE Eng Med Biol Soc. 2019 Jul;2019:4660-4663.

Villegas B, Flores KM, Jose Acuna K, Pacheco-Barrios K, Elias D.

Stuttering is the principal fluency disorder that affects 1% of the world population. Growing with this disorder can impact the quality of life of the adults who stutter (AWS). To manage this condition, it is necessary to measure and assess the stuttering severity before, during and after any therapeutic process. The respiratory biosignal activity could be an option for automatic stuttering assessment, however, there is not enough evidence of its use for this purposes. Thus, the aim of this research is to develop a stuttering disfluency classification system based on respiratory biosignals. Sixty-eight participants (training: AWS=27, AWNS=33; test: AWS=9) were asked to perform a reading task while their respiratory patterns and pulse were recorded through a standardized system. Segmentation, feature extraction and Multilayer Perceptron Neural Network (MLP) was implemented to differentiate block and non-block states based on the respiratory biosignal activity. 82.6% of classification accuracy was obtained after training and testing the neural network. This work presents an accurate system to classify block and non-block states of speech from AWS during reading tasks. It is a promising system for future applications such as screening of stuttering, monitoring and biofeedback interventions.

PMID: 31946902 DOI: 10.1109/EMBC.2019.8857891

A single case report of a patient with stuttering who improved after open label TMS. - NEUROCIÊNCIAS

Brain Stimul. 2019 Jan 19. [Epub ahead of print]

Mejías G, Prieto J.

Hospital General Universitario Gregorio Marañón, Madrid, Spain.

No abstract available.

PMID: 30704893 DOI: 10.1016/j.brs.2019.01.011

An evaluation of an integrated fluency and resilience program for early developmental stuttering disorders - EMOCIONAL

J Commun Disord. 2019 Mar - Apr; 78:69-83. Epub 2019 Feb 15

Druker KC, Mazzucchelli TG, Beilby JM.

Curtin University, Western Australia, Australia.

PURPOSE: The temperament construct of effortful control, an index of self-regulation and resilience, has been found to be predictive of stuttering severity in children and is a potential indicator of clinical prognosis. Evidence supports early intervention for preschool stuttering, and the successful effect of parents as agents of change in their children's stuttering therapy. However, no previous studies have trained parents to improve self-regulation in their children as a component of stuttering therapy. This study aimed to explore the effects of addressing self-regulation, as a component of stuttering treatment, on child fluency as well as parent and child psychosocial outcomes.

METHODS: This study implemented a preliminary parent administered resilience component in conjunction with stuttering therapy for children who stutter, and compared outcomes to a cohort of children who stutter who received stuttering therapy only. Twenty-eight children who stutter were randomly allocated to one of the two treatment groups. Dependent variables tested pre- and post-treatment included stuttered speech severity, parenting practices, and child resilience indicators. Outcomes were compared between groups at post treatment.

RESULTS: Stuttered speech severity decreased in both treatment groups. A reduction in behavioural and emotional problems, and increase in resilience was observed in the children who stutter whose parents received the additional resilience component of therapy. Furthermore, a significant improvement in parenting practices was demonstrated in this group. No significant changes in emotional and behavioural problems in children or parents were observed in the group of children who received fluency therapy only.

CONCLUSION: Results demonstrate that implementation of the resilience component was successful in positively shifting parenting practices and increasing behavioural resilience in children who stutter. This has clinical implications for successfully managing fluency while concurrently targeting the concomitant behavioural and emotional impacts of the disorder on both children and parents, potentially a key future prognostic indicator of the maintenance of fluency outcomes.

New York University, New York, NY, United States; University of Iowa, Iowa City, IA, United States.

PURPOSE: We previously introduced theStuttering Anticipation Scale (SAS; Jackson, E. S., Gerlach, H., Rodgers, N. H., & Zebrowski, P. M. (2018). My Client Knows That He's About to Stutter: How Can We Address Stuttering Anticipation during Therapy with Young People Who Stutter? Seminars in Speech and Language, 39, 356-370) - a non-standardized self-report measure for children, teens, and adults who stutter (CWS, TWS, AWS) that quantifies how often they engage in 25 commonly reported action responses to anticipation. The purpose of this study was to leverage the SAS to explore the factor structure of action responses to stuttering anticipation.

METHODS: A total of 121 people who stutter completed the SAS online (27 CWS, 40 TWS, 54 AWS). We used exploratory factor analysis (EFA) to determine the underlying latent variables within the 25 SAS items that characterize how people who stutter respond to anticipation.

RESULTS: A three-factor model was most appropriate for the data with regard to factor loadings and other model fit indices. The three factors were named: avoidance (17 items), physical change (4 items), and approach (4 items).

CONCLUSION: Understanding these three types of action responses to anticipation can help guide clinical decision-making by providing a novel framework for clinicians and their clients who stutter to discuss how the client tends to respond to anticipation, and explore ways to facilitate productive responses to anticipation.

Persistent developmental stuttering is a neurological disorder that commonly manifests as a motor problem. Cognitive theories, however, hold that poorly developed cognitive skills are the origins of stuttering.Working memory (WM), a multicomponent cognitive system that mediates information maintenance and manipulation, is known to play an important role in speech production, leading us to postulate that the neurophysiological mechanisms underlying stuttering may be associated with a WM deficit. Using functional magnetic resonance imaging, we aimed to elucidate brain mechanisms in a phonological WM task in adults who stutter and controls. A right-lateralized compensatory mechanism for a deficit in the rehearsal process and neural disconnections associated with the central executive dysfunction were found. Furthermore, the neural abnormalities underlying the phonological WM were independent of memory load. This study demonstrates for the first time the atypical neural responses to phonological WM in PWS, shedding new light on the underlying cause of stuttering.

PMID: 30145850 DOI: 10.1002/hbm.24366

After the RESTART trial: six guidelines for clinical trials of early stuttering intervention. - OUTRAS ÁREAS

Int J Lang Commun Disord. 2019 Feb 17. [Epub ahead of print]

Onslow M, Lowe R.

The University of Sydney, Sydney, NSW, Australia.

BACKGROUND: The Rotterdam Evaluation Study of Stuttering Therapy randomized trial (RESTART) was seminal, comparing the Lidcombe Program with RESTART Demands and Capacities Model-based treatment (RESTART-DCM) for pre-school age children who stutter.

AIMS: To critique the methods of the RESTART trial to develop guidelines for its systematic replication and extension. Beyond that, to contribute to the refinement of existing methodological guidelines for early stuttering intervention.

METHOD: The discussion is organized around methodological issues of primary outcomes, treatment completion, clinician allegiance, treatment fidelity, age exclusions and no-treatment control reasoning.

MAIN CONTRIBUTION: We recommend six methodological guidelines to guide future clinical trials comparing the Lidcombe Program with RESTART-DCM, which can be applied to clinical trials of other early stuttering intervention methods: (1) incorporate a continuous measure of primary outcome; (2) ensure that all children in clinical trials have completed treatment; (3) eliminate potential bias due to clinician allegiance; (4) establish treatment fidelity within and beyond the clinic; (5) include children younger than 3 years in clinical trials; and (6) establish an estimate of treatment effect size at some stage of treatment development.

CONCLUSION: In addition to guiding future clinical research comparing RESTART-DCM and Lidcombe Program treatment, these recommendations may extend to influence positively other treatment developments for early stuttering.

The aim was to determine how backward-looking sentence processing is affected by typically-disfluent versus stuttered speech. Two listener groups heard Garden Path (GP) and control sentences. GP sentences contained no disfluency, a silent pause, or a filled pause before the disambiguating verb. For one group, the sentence preambles additionally contained stuttering-like disfluencies. Comprehension accuracy, event-related potentials (ERPs) time-locked to disambiguating verbs, and perceptual speaker ratings, were compared between groups. The With Stuttering group perceived the speaker as less competent but had better comprehension accuracy for GP sentences. ERPs to disambiguating verbs in GP sentences included a P600 component, indexing backward-looking sentence processing, but only for the No Stuttering group. Other ERP components, elicited to GP sentences with silent/filled pauses, did not differ between groups. Results suggest that listeners abandon prior expectations when processing sentences containing stuttering-like disfluencies, possibly because they lack a speaker model defined by the presence of stuttering.

Kermanshah University of Medical Sciences , Kermanshah , Iran; National and Kapodistrian University of Athens , Athens , Greece.

The causes of developmental stuttering, a neurodevelopmental communicative disorder, have not been elucidated to date. Neuroimaging studies suggest that atypical cerebral laterality could be one of such causal factors. Moreover, handedness, a behavioural index for cerebral laterality, has been linked to stuttering and recovery from it. However, findings are conflicting, possibly due to sample selection procedures, which typically rely on self-reported stuttering, and to the fact that handedness is typically assessed with regards to its direction rather than degree. We investigated the possible relationship between handedness and stuttering. This is the first study where children who stutter (CWS) were selected using clinical criteria as well as speech samples and where a non-Western population was studied. Findings from 83 CWS aged 3-9 years (mean = 6.43, SD = 1.84) and 90 age- and sex-matched children who do not stutter (mean = 6.45, SD = 1.71) revealed no differences in their hand preference scores as evaluated by parent-completed Edinburgh Handedness Inventory, for both direction and degree. The severity of stuttering was not found to correlate with the degree of handedness. We suggest that parents and professionals not treat left- or mixed-hand preference as a reason for concern with regards to stuttering.

University of Nigeria, Nsukka, Nigeria; Federal College of Education (Technical), Umunze, Nigeria.

OBJECTIVE: To determine the effectiveness of a cognitive behaviour language therapy (CBLT) programme to reduce speech anxiety among stuttering school adolescents.

METHODS: This was a group randomized clinical trial that enrolled stuttering school adolescents who had severe speech anxiety. The participants were randomized to either the treatment group or the control group. The Speech Anxiety Thoughts Inventory (SATI) score was recorded before and after a 12-week CBLT programme was delivered in 24 group sessions to the treatment group.The control group did not receive any therapy.

BACKGROUND: Theories relating to young children's social cognitive maturity and their prevailing social groups play important roles in the acquisition of attitudes. Previous research has shown that preschool and kindergarten children's stuttering attitudes are characterized by stronger negative beliefs and self reactions than those of parents. By contrast, 12 year-old children's stuttering attitudes have been shown to be similar to their parents' attitudes. Other research indicates that parental stuttering attitudes are no different from attitudes of adults who are not parents.

PURPOSE: The purpose of this study was to explore children's stuttering attitudes of preschool through 5th grade children and to compare them to their parents' attitudes.

METHOD: Children and parents from a rural Appalachian elementary school and child/parent pairs from other areas in the region responded to child and adult versions of the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S/Child and POSHA-S). Seven grade levels were included: preschool, kindergarten, 1st grade, 2nd grade, 3rd grade, 4th grade, and 5th grade.

RESULTS: Confirming earlier research, younger children's attitudes toward stuttering were considerably less positive than those of their parents.As children matured up to the fifth grade, however, their stuttering attitudes progressively were more positive. Parents' stuttering attitudes were quite consistent across all seven grade levels.

CONCLUSIONS: Consistent with theories of attitudinal development, between the ages of 4 and 11 years, children's measured attitudes toward stuttering improved and gradually approximated the attitudes of their parents and the general public.

All India Institute of Speech and Hearing, Manasagangothri, Mysuru, India,

BACKGROUND: Recent models of speech production suggest a link between speech production and perception. Persons with stuttering are known to have deficits in sensorimotor timing and exhibit auditory processing problems. Most of the earlier studies have focused on assessing temporal ordering in adults who stutter (AWS), but limited attempts have been made to document temporal resolution abilities in AWS.

METHODS: A group of 16 AWS and 16 age- and gender-matched adults who do not stutter (AWNS) were recruited for the study. Temporal resolution abilities were assessed using the Gap Detection Test and temporal modulation transfer function (TMTF).

RESULTS: The results revealed significant differences in TMTF between AWS and AWNS, but no differences were found in the gap detection thresholds.

CONCLUSIONS: Results suggest that the sensory representations of the temporal modulations are compromised in AWS, which may contribute to the programming of rhythmic movements during speech planning.

PMID: 31132766 DOI: 10.1159/000499565

Differences in the relation between temperament and vocabulary based on children's stuttering trajectories - EMOCIONAL

J Commun Disord. 2019 Jan 25;78:57-68. [Epub ahead of print]

Singer CM, Walden TA, Jones RM.

Vanderbilt University, Nashville, TN, United States

PURPOSE: The purpose of this study was to assess the relation between temperament and vocabulary development for children who stutter and persist, children who stutter and recover and children who do not stutter.

METHODS: Participants, aged 3;0-4;11 at the start of the study, were followed for two years. They were classified as persisting (n = 10), recovered (n = 26), and non-stuttering (n = 24) based on multiple assessments of stuttering spaced across study participation. Groups were balanced for age and gender ratios. At each visit, participants completed the Peabody Picture Vocabulary Test, 4th edition, and the Expressive Vocabulary Test, 2nd edition; caregivers completed the Children's Behavior Questionnaire.

RESULTS: For both persisting and recovered groups, higher negative emotionality was associated with lower receptive vocabulary. These associations were both significantly more negative than the non-stuttering group's association.

CONCLUSION: These findings suggest that receptive vocabulary development is differentially linked to temperament based on a child's stuttering status. As others have speculated (Conture & Walden, 2012), it appears as though there are salient associations between temperament, speech-language development, and childhood stuttering.

PMID: 30771599 DOI: 10.1016/j.jcomdis.2019.01.004

Disfluency clusters in speakers with and without neurogenic stuttering following traumatic brain injury - GAGUEIRA ADQUIRIDA

J Fluency Disord. 2019 Jan 11;59:33-51. [Epub ahead of print]

Penttilä N, Korpijaakko-Huuhka AM, Kent RD.

University of Tampere, Tampere, Finland; University of Wisconsin-Madison, Madison WI, United States.

PURPOSE: Analyze the characteristics and rate of disfluency clusters in adults with and without neurogenic stuttering after traumatic brain injury (TBI).

METHOD: Twenty adults with TBI participated in this study, including 10 with neurogenic stuttering (Group B) and 10 without -stuttering (Group A). Disfluency clusters in speech samples were classified into three types: Stuttering-like (SLD), other (OD), and mixed (MIX).

RESULTS: Speakers with and without neurogenic stuttering produced the same mean number of disfluency clusters. In addition, the mean length of clusters did not differ between these speaker groups although the longest clusters did. The most frequently occurring cluster type for people with neurogenic stuttering was MIX and OD for people without stuttering. Although the speakers in Group A produced stuttering-like disfluencies, these never occurred together to form a SLD type cluster. For Group B, the starter units of the clusters were usually stuttering-like disfluencies, while for Group A, the starter units were mostly interruptions.

CONCLUSIONS: Compared to non-stuttering speakers, stuttering after TBI did not increase the number of clusters, but rather lengthened them. In speakers with neurogenic stuttering, the number and length of clusters were related to the manifestation of other communication deficits, not to the frequency of stuttering-like disfluencies. Still, SLD clusters occurred only in those people with neurogenic stuttering. These findings raise questions about the nature of both neurogenic stuttering and the dynamics of disfluency clustering.

PMID: 30641458 DOI: 10.1016/j.jfludis.2019.01.001

Dissociating motor-speech from lexico-semantic systems in the left frontal lobe: insight from a series of 17 awake intraoperative mappings in glioma patients - NEUROCIÊNCIAS

Functional brain mapping during awake surgery procedures is the gold standard technique in the management of left frontal lobe tumors. Nevertheless, a unified picture of the language subsystems encountered during left frontal lobe mapping is still lacking. We retrospectively analyzed the 49 cortical and the 33 axonal sites of functional language mapping performed in 17 patients operated for a left frontal lobe glioma under awake conditions. Sites were tagged on the postoperative MRI, based on anatomical landmarks and intraoperative photography. All MRIs and tags were then registered in the MNI template. Speech disturbances related to motor functions (speech arrest-with or without superior limb arrest-, stuttering, and vocalization) were grouped together as "motor-speech" responses.Anomias, semantic paraphasia, perseverations, and PPTT errors were classified as "lexico-semantic" responses. MNI-registered axonal sites were used as seed for computing disconnectome maps from a tractogram atlas of ten healthy individuals, as implemented in the BCB toolkit. The cortical distribution of lexico-semantic responses appeared to be located anteriorly (pars triangularis of the inferior frontal gyrus and posterior end of the middle and superior frontal gyrus) compared to motor-speech responses (lower end of the precentral gyrus and pars opercularis). Within the white matter, motor-speech responses and lexico-semantic responses overlapped on the trajectory of the aslant and fronto-striatal tracts, but the lexico-semantic sites were located more anteriorly (mean Y coordinate on the MNI system was 21.2 mm for lexico-semantic sites and 14.3 mm for the motor-speech sites; Wilcoxon test: W = 60.5, p = 0.03). Moreover, disconnectome maps evidenced a clear distinction between the two subsystems: posterior fronto-striatal and frontal aslant tracts, corpus callosum and cortico-spinal tract were related to the motor-speech sites, whereas anterior frontal aslant tract, inferior-fronto-occipital fasciculus (IFOF) and anterior thalamic radiations were related to the lexico-semantic sites. Hence, we evidenced distinct anatomical substrates for the motor-speech and lexico-semantic systems. Regarding the aslant/fronto-striatal system, an anterior to posterior gradient was found, with a lexico-semantic role for the anterior part and a motor-speech involvement for the posterior part. For tumors abutting the precentral sulcus, posterior boundaries of the resection are made of motor-speech sites, meaning that the anteriorly located lexico-semantic system is no more functional, as a result of network reorganization by plasticity.

PMID: 30637492 DOI: 10.1007/s00429-019-01827-7

Effects of Social Stress on Autonomic, Behavioral, and Acoustic Parameters in Adults Who Stutter - EMOCIONAL

J Speech Lang Hear Res. 2019 Jul 2:1-18 [Epub ahead of print]

Bauerly KR, Jones RM, Miller C.

University of Vermont, Burlington; Vanderbilt University Medical Center, Nashville, TN.

The purpose of this study was to assess changes in autonomic, behavioral, and acoustic measures in response to social stress in adults who stutter (AWS) compared to adults who do not stutter (ANS). Participants completed the State-Trait Anxiety Inventory ( Speilberger, Gorsuch, Luschene, Vagg, & Jacobs, 1983 ). In order to provoke social stress, participants were required to complete a modified version of the Trier Social Stress Test (TSST-M, Kirschbaum, Pirke, & Hellhammer, 1993 ), which included completing a nonword reading task and then preparing and delivering a speech to what was perceived as a group of professionals trained in public speaking. Autonomic nervous system changes were assessed by measuring skin conductance levels, heart rate, and respiratory sinus arrhythmia (RSA). Behavioral changes during speech production were measured in errors, percentage of syllable stuttered, percentage of other disfluencies, and speaking rate. Acoustic changes were measured using 2nd formant frequency fluctuations. In order to make comparisons of speech with and without social-cognitive stress, measurements were collected while participants completed a speaking task before and during TSST-M conditions. Results AWS showed significantly higher levels of self-reported state and trait anxiety compared to ANS. Autonomic nervous system changes revealed similar skin conductance level and heart rate across pre-TSST-M and TSST-M conditions; however, RSA levels were significantly higher in AWS compared to ANS across conditions. There were no differences found between groups for speaking rate, fundamental frequency, and percentage of other disfluencies when speaking with or without social stress. However, acoustic analysis revealed higher levels of 2nd formant frequency fluctuations in the AWS compared to the controls under pre-TSST-M conditions, followed by a decline to a level that resembled controls when speaking under the TSST-M condition. Discussion Results suggest that AWS, compared to ANS, engage higher levels of parasympathetic control (i.e., RSA) during speaking, regardless of stress level. Higher levels of self-reported state and trait anxiety support this view point and suggest that anxiety may have an indirect role on articulatory variability in AWS.

PMID: 31265363 DOI: 10.1044/2019_JSLHR-S-18-0241

'Exploring stuttering severity in the Egyptian Arabic speaking children who stutter: A correlation study of Bloodstein classification of stuttering severity and the stuttering severity instrument for children and Adults-Arabic Version' - AVALIAÇÃO

OBJECTIVE: The aim of this study was to explore the magnitude of stuttering severity in the Egyptian Arabic speaking children who stutter (CWS) by corelating stuttering severity grades assessed by Bloodstein classification of stuttering severity (BLS) and by the stuttering severity instrument for children and adults-Arabic version (ASSI).

METHODS: 58 Egyptian Arabic speaking CWS aged 5-9 years and 9 months, were selected conveniently upon inclusion and exclusion criteria from patients frequented at the Phoniatrics clinic of El-Demerdash hospital (Ain Shams University). Through an observational cross-sectional study, the selected children underwent the Ain Shams university assessment protocol of fluency disorders, including clinician's assessment of stuttering severity by BLS classification and ASSI. The correlation between the grade of stuttering severity by BLS classification and ASSI were analyzed by Spearman's correlation coefficient and regression analysis.

RESULTS: Significant positive correlation was found between grades of stuttering severity measured by BLS classification and ASSI. Among children with mild, moderate and severe degrees of stuttering by BLS classification, the score of their ASSI decrease as the child's age increases. The age of the participated CWS was significantly inversely related to the score of ASSI, yet it is not related to the grades of BLS classification. The age of onset of stuttering was not related to stuttering severity whether measured by BLS classification or ASSI.

CONCLUSION: There is a significant positive relationship between stuttering severity measured by BLS classification and ASSI. Speech disfluencies counted by ASSI decreases as the child's age increases, in relation to stuttering severity by BLS classification. Clinicians should depend on more than one tool while assessing stuttering severity.

PMID: 31252197 DOI: 10.1016/j.ijporl.2019.06.014

Exposure therapy for social anxiety disorder in people who stutter: An exploratory multiple baseline design. - SOCIAL

J Fluency Disord. 2019 Mar;59:21-32. Epub 2018 Dec 13.

Scheurich JA, Beidel DC, Vanryckeghem M.

University of Central Florida, Orlando,, United States.

BACKGROUND & OBJECTIVES: Social anxiety disorder (SAD) is a debilitating condition, and approximately half of adults who stutter have SAD. Cognitive-behavioral therapy (CBT) has shown promise in decreasing social anxiety symptoms among adults who stutter, but exposure, arguably the essential component for successful CBT for SAD, has been understudied and underemphasized. Aims of this study were to develop an exposure therapy protocol designed specifically for people who stutter and have SAD and evaluate its potential efficacy in reducing social anxiety and stuttering severity using a multiple baseline design.

METHODS: Six participants received ten sessions of exposure therapy. Participants reported daily social anxiety, and social distress and stuttering severity were evaluated at major assessment points.

RESULTS: There were substantial reductions in social anxiety and considerable improvements in affective, behavioral, and cognitive experiences of stuttering. No consistent change was observed for stuttering frequency. Gains were mostly maintained after six-months.

CONCLUSIONS: Results suggest that the novel exposure approach may decrease social distress, but not necessarily influence speech fluency. These findings underscore the importance of the assessment and treatment of SAD among adults who stutter and suggest that the integration of care between clinical psychologists and speech-language pathologists may prove beneficial for this population.

PURPOSE: We investigated whether outcomes of therapy for persistent developmental stuttering differ in individuals who carry a mutation in one of the known genes associated with stuttering compared to individuals without such mutations.

METHOD: We studied outcomes of an intensive fluency shaping-based therapy program in individuals with persistent developmental stuttering. We evaluated a cohort of 51 stuttering individuals with who carried a mutation in either the GNPTAB, GNPTG, NAGPA, or AP4E1 gene. We compared therapy outcomes in these individuals with outcomes in 51 individuals matched for age, gender, and ethnicity, who stutter and underwent the same therapy program, and did not carry a mutation in any of these genes. Fluency pre- and post-therapy was evaluated using blinded observer-based quantitative stuttering dysfluency measures (Dysfluent Words Score, DWS), and by subjects' self-reported measures of struggle, avoidance and expectancy behavior associated with speaking (Perceptions of Stuttering Inventory, PSI). The difference between pre- and post-therapy fluency scores was taken as the measure of near-term therapy efficacy.

RESULTS: Comparison of fluency measures showed a strong effect of therapy overall. Mutation carriers achieved significantly less resolution in PSI following therapy, with PSI scores showing significantly less improvement in individuals who carry a mutation (p = 0.0157, RR = 1.75, OR = 2.92) while the group difference in DWS between carriers and non-carriers was statistically not significant in the present study, the trend observed in the results warrants further research focused on this important issue.

CONCLUSIONS: These results suggest stuttering is more resistant to therapy in individuals who carry a mutation in one of the genes known to be associated with stuttering.

There have been controversial debates across multiple disciplines regarding the underlying mechanism of developmental stuttering. Stuttering is often related to issues in the speech production system; however, the presence and extent of a speech perception deficit is less clear. This study aimed to investigate the speech perception of children who stutter (CWS) using the categorical perception paradigm to examine their ability to categorize different acoustic variations of speech sounds into the same or different phonemic categories. In this study, 15 CWS and 16 children who do not stutter (CWNS) completed identification and discrimination tasks involving acoustic variations of Cantonese speech sounds in three stimulus contexts: consonants (voice onset times, VOTs), lexical tones, and vowels. The results showed similar categorical perception performance in boundary position and width in the identification task and similar d' scores in the discrimination task between the CWS and CWNS groups. However, the reaction times (RTs) were slower in the CWS group compared with the CWNS group in both tasks. Moreover, the CWS group had slower RTs in identifying stimuli located across categorical boundaries compared with stimuli located away from categorical boundaries. Overall, the data implied that the phoneme representation evaluated in speech perception might be intact in CWS as revealed by similar patterns in categorical perception as those in CWNS. However, the CWS group had slower processing speeds during categorical perception, which may indicate an insufficiency in accessing the phonemic representations in a timely manner, especially when the acoustic stimuli were ambiguous.

PMID: 31026270 DOI: 10.1371/journal.pone.0216124

In-Clinic and Standalone Internet Cognitive Behavior Therapy Treatment for Social Anxiety in Stuttering: A Randomized Trial of iGlebe - EMOCIONAL

The University of Sydney, New South Wales; The University of Queensland, Brisbane, Australia.

Purpose iGlebe is an individualized, fully automated Internet cognitive behavior therapy (CBT) treatment program that requires no clinician contact. Phase I and II trials have demonstrated that it may be efficacious for treating the social anxiety commonly associated with stuttering. The present trial sought to establish whether the outcomes achieved by iGlebe are noninferior to those associated with in-clinic CBT from clinical psychologists. Method Fifty adults with stuttering were randomized to receive in-clinic CBT for anxiety or 5 months online access to iGlebe. The design was a noninferiority randomized controlled trial with outcomes assessed at prerandomization and at 6 and 12 months postrandomization. Primary outcomes were CIDI-Auto-2.1 diagnoses for anxiety and mood disorders and Brief Fear of Negative Evaluation scale scores ( Carleton, McCreary, Norton, & Asmundson, 2006 ). Secondary outcomes included speech, psychology, and quality-of-life measures. Results Outcomes consistently showed clinically significant improvements of around a medium effect size for the cohort as a whole from prerandomization to 6 months postrandomization, which were maintained at 12 months postrandomization. Comparisons between the 2 treatments showed little difference between iGlebe and in-clinic treatment for all primary and secondary outcomes, with last observation carried forward for missing data. Conclusions iGlebe is a promising individualized treatment for social anxiety for adults who stutter and offers a viable and inexpensive alternative to in-clinic CBT with clinical psychologists. An issue to emerge from this trial, which requires clarification during future clinical trials of iGlebe, is the posttreatment relation between percentage of syllables stuttered and self-reported stuttering severity ratings.

BACKGROUND: Treatment outcome data for children with severe speech sound disorders with motor speech involvement (SSD-MSI) are derived from Phase I clinical research studies. These studies have demonstrated positive improvements in speech production. Currently there is no research examining the optimal treatment dose frequency for this population. The results of this study, which is the first of its kind, will inform the delivery of effective services for this population.

AIMS: To investigate optimal treatment dose frequency for the Motor Speech Treatment Protocol (MSTP) for children with SSD-MSI.

METHODS & PROCEDURES: A total of 48 children (aged 43-47 months) with SSD-MSI participated in the study. Participants received 45-min MSTP intervention sessions either once per week (lower dose frequency) or twice per week (higher dose frequency) for a 10-week period. Blinded outcome assessments were carried out at pre- and post-intervention.

OUTCOMES & RESULTS: Treatment-related change was assessed at body structures, functions and activities participation level as per the World Health Organization's International Classification of Functioning framework: Children and Youth Version (ICF-CY) framework WHO (). These measures are related to articulation, functional communication and speech intelligibility. One-way analysis of variance (ANOVA) revealed that for all variables the baseline scores were not statistically different (p > 0.05) between the two dose-frequency groups. Overall, there was a significant main effect of Time (pre-post) across all variables (p < 0.01). However, repeated-measures ANOVA did not result in any statistical interactions (Time × Dose frequency) for any of the variables tested (p > 0.05). Only marginal clinical advantages (< 4% change in intelligibility) were noted with the 10 extra sessions.

CONCLUSIONS & IMPLICATIONS: Overall, the MSTP intervention approach in conjunction with home practice led to significant positive changes for all measures in children with SSD-MSI. No statistical differences between high- and low-dose-frequency groups were observed for any of the variables. Clinical effects were examined using effect sizes, as well as changes in articulation, speech intelligibility and functional communication; these differed marginally between the two dose frequencies. This suggests limited benefits of 10 additional sessions per block. Thus, it is recommended that caregivers, speech-language therapists and policy-makers perform a cost-benefit analysis before determining the dose frequency, when considering additional sessions per block.

Harvard University , Cambridge, MA; University of Maryland, College Park; Purdue University, West Lafayette, IN.

Purpose This response addresses comments made by Marcotte (2019) regarding our recent publication, "Preliminary Evidence That Growth in Productive Language Differentiates Childhood Stuttering Persistence and Recovery" ( Leech, Bernstein Ratner, Brown, & Weber, 2017 ). Marcotte calls into question our finding that language growth is a valid predictor of recovery from stuttering because we did not account for treatment and family history. Conclusions In response to her comments, we provide additional empirical analyses couched in a larger discussion of the difficulty of calibrating treatment and family history of stuttering. In short, we show that once treatment history and family history of stuttering are accounted for, the effect of language growth remains a significant predictor of stuttering persistence.

Stuttering is a speech fluency disorder with varied etiological explanations. It is important to identify symptoms early so that adequate and timely intervention can be delivered with focus on management and recovery. Stuttering, besides affecting speech fluency, might have a number of negative psychosocial consequences for the sufferer that may lead to immense anxiety, besides other symptoms. Therefore, it is thus imperative to include multiple dimensions in the holistic treatment of stuttering. Cognitive behavior therapy and mindfulness equip the client with the skills to manage the problems that occur as a result of stuttering. Since the rate of relapse in this condition is high, the chosen therapeutic paradigm must involve booster sessions over a long term. Periodic, detailed assessment would update the therapist about the barriers in treatment and would help in devising appropriate methods to get rid of these hindrances.

PMID: 31879440 PMCID: PMC6929220 DOI: 10.4103/ipj.ipj_18_19

Newly Recognized Stuttering in Three Young Children Following the Hojedk Earthquake in Iran - EMOCIONAL

Natural disasters, particularly earthquakes, in addition to physical complications, have always had psychological consequences for those affected by them. Stuttering is one of the psychological consequences of shocking events. After a 6.6 magnitude earthquake in Hojedk, Kerman, Iran, two 5-year-old children and a 4-year-old child with symptoms of discontinuous speech (including repeated sound, syllable, and words) were referred to the Kerman Welfare Organization's rehabilitation center (Kerman, Iran). After history-taking, it became clear that the children had begun to stutter after the earthquake due to fear and stress. Considering the importance of negative emotional experiences in the onset of stuttering, it cannot really be said with certainty that the negative experience of the earthquake initiated the stuttering. Rather, the stuttering had not been present before the earthquake and appeared after the event. These cases indicate the importance of psychosocial support and speech therapy after disasters, especially for children that have higher psychological vulnerability than other age groups.

PMID: 31237226 DOI: 10.1017/S1049023X19004497

Novel PANK2 mutation in a Chinese boy with PANK2-associated neurodegeneration: A case report and review of Chinese cases.- GENÉTICA

Medicine (Baltimore). 2019 Jan;98(4):e14122.

Zhang Y, Zhou D, Yang T.

West China Hospital, Sichuan University, Chengdu, China

RATIONALE: Pantothenate kinase-associated neurodegeneration (PKAN), also called Hallervorden-Spatz Syndrome (HSS), is a rare neurodegeneration with brain iron accumulation from pantothenate kinase 2 gene (PANK2) mutation characterized as extrapyramidal symptoms. However, few studies involving PKAN patients were reported in China. This study was conducted to identify the genetic mutations in a Chinese boy with PKAN, and to review all PANK2 mutations reported in Chinese cases with PKAN.

PATIENT CONCERN: We reported a 23-year-old Chinese boy with PKAN, exhibiting difficulty in writing and manipulation using right hand with slow progression for 12 years. He spoke with a severe stutter when he was 15 years old.

DIAGNOSIS: Considering results of magnetic resonance images, brain computed tomography and medical history, the case was suspected to be related to genetic factors.

INTERVENTIONS: Whole exome sequencing was arranged, and the mutations were identified in his parents' genome.

OUTCOMES: In the present study, whole exome sequencing revealed 2 novel mutations (c.1696C > G in exon 7 and c.1160_c.1161insG in exon3) of the PANK2 gene in the proband. c.1696C > G and c.1160_c.1161insG, respectively, were confirmed in his father and mother. We also reviewed 14 different PANK2 mutations, most of which were missense type in Chinese cases. Those mutations did not show apparent hotspots, but exon 3 and 4 were frequently involved.

LESSONS: Two novel compound heterozygous mutations were identified and considered to be pathogenic in PKAN patients. This review of the reports indicated that atypical PKAN is the more common phenotype in China and no apparent genotype-phenotype correlation was found.

PMID: 30681573 DOI: 10.1097/MD.0000000000014122

Phonological and Semantic Contributions to Verbal Short-Term Memory in Young Children With Developmental Stuttering. - INFANTIL

Purpose The purpose of this study was to examine the verbal short-term memory skills of children who stutter (CWS) and children who do not stutter (CWNS) in 2 experiments, focusing on the influence of phonological and semantic similarity. Method Participants were 42 CWS and 42 CWNS between the ages of 3;0 and 5;11 (years;months). In Experiment 1, children completed the phonological similarity task, in which they listened to lists of phonologically similar and dissimilar words and then repeated them when signaled to do so. In Experiment 2, children completed another forward span task, the semantic category task, which is similar to the phonological similarity task, except that it consisted of lists of semantically homogeneous and heterogeneous words. Main dependent variables were cumulative memory span, proportion of errors by type, and speech reaction time (SRT) for correct responses. Results The CWS exhibited significantly shorter memory spans for phonologically dissimilar words and were less affected by the phonological qualities of the words than the CWNS in Experiment 1, based on the findings of both between-groups and within-group analyses. In Experiment 2, although the groups did not differ in their performance in either condition, within-group analyses revealed that the CWNS benefitted from semantic similarity, whereas the CWS did not. The between-groups difference in absolute difference scores, however, did not reach significance. The CWS produced more omissions and false alarms than the CWNS in both experiments, but the 2 groups of children were otherwise comparable in SRT, although the CWS exhibited overall faster SRT than the CWNS in Experiment 2. Conclusions Verbal short-term memory is one domain-general cognitive process in which CWS display weakness relative to typically fluent peers. These weaknesses are likely due, in part, to differences in phonological and, perhaps, semantic processing of words to aid memory.

PMID: 30950742 DOI: 10.1044/2018_JSLHR-S-18-0039

Pilot Program Combining Acceptance and Commitment Therapy with Stuttering Modification Therapy for Adults who Stutter: A Case Report - TERAPIA

BACKGROUND: The impact of stuttering far exceeds its effects on speech production itself. It includes increased anxiety levels and avoidance of speech situations that may impact the general quality of life. Therefore, psychological treatment methods have been incorporated into speech therapy programs with positive results. Acceptance and commitment therapy (ACT) is a relatively recent addition to the field of stuttering. In this case report, we present a pilot program of integrating acceptance and commitment therapy (ACT) with stuttering modification therapy for adults who stutter.

METHOD: Eight adults who stutter entered the approximately year-long program, which consisted of three parts: group ACT, individual/pair stuttering modification therapy, and monthly stabilization/follow-up sessions.

RESULTS: Improvement was observed in group mean measures of mindfulness skills, speech-related attitudes, anxiety, daily communication, quality of life, and stuttering frequency. Improvement in quality of life was also self-described by participants throughout the program.

CONCLUSIONS: Participant improvement and positive self-reports suggest a potentially promising effect of combining ACT with stuttering modification therapy. Further research is needed to evaluate treatment efficacy.

PMID: 31256158 DOI: 10.1159/000501078

Psychiatric and Behavioral Complications of GPi DBS in an Adolescent with Myoclonus Dystonia - OUTRAS ÁREAS

Myoclonus dystonia is a rare movement disorder that often causes significant disability. Deep brain stimulation of the internal pallidum (GPi DBS) is a recommended treatment for those who do not respond to pharmacotherapy or who have intolerable side effects. This paper reports on the case of a 17-year-old male who was admitted to a tertiary level mental healthcare facility for treatment of psychiatric and behavioral symptoms thought to be related to GPi DBS. Prior to GPi DBS insertion, the patient was diagnosed with anxiety and mild obsessive compulsive disorder (OCD). Following insertion, his OCD became severe and he developed depression, Tourette syndrome, and stuttering. His first admission to a psychiatric unit was for management of a manic episode following treatment for depression with fluoxetine, and he began to exhibit severe aggressive behavior. GPi DBS was turned off, but there were neither changes in dystonic movements nor improvement in aggressive behavior or psychiatric symptoms, though stuttering improved. The patient was transferred to a secure treatment centre where he was able to gain control over his behaviors with intense dialectical behavior therapy, but the aggressive behavior and safety concerns continue to persist today.

PMID: 31275687 PMCID: PMC6582850 DOI: 10.1155/2019/1947962

Reliability and validity of the UTBAS-TR (The Unhelpful Thoughts and Beliefs Scale-the Turkish version) in the Turkish population - AVALIAÇÃO

PURPOSE: This paper decribes the development of the Turkish adaptation of UTBAS (UTBAS-TR) and reports the results concerning its applicability and psychometric structure.

METHOD: The sample consisted of 81 males and 19 females diagnosed with developmental stuttering in two centres. Test-retest reliability score was obtained by correlating results of repeated aplications of the scale within a one-week interval and a paired t-test was calculated to see the differences in the total and UTBAS I, II and III scores. The internal consistency was assessed using the Cronbach's alpha. Construct validity was also assessed by examining inter-scale correlations and with the correlations of the UTBAS-TR with two other scales (State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BAI)).

RESULT: The internal consistency of the UTBAS-TR and the test and retest reliability score was statiıstically significant. The correlation between UTBAS-TR total score and the UTBAS-TR I, II and III correlations were high. A significant correlation was observed between UTBAS-TR total score with State Anxiety Inventory. However, the correlations between UTBAS-TR-Total Score and Trait Anxiety Inventory and Beck Anxiety Inventory were low.

CONCLUSION: The UTBAS-TR proved to be suitable for use with the Turkish population.

PMID: 30856006 DOI: 10.1080/17549507.2019.1568572

Response to the Letter to the Editor From Marcotte (2019) Regarding "The History of Stuttering by 7 Years: Follow-Up of a Prospective Community Cohort" by Kefalianos et al. (2017) - TERAPIA

Purpose The purpose of this letter is to respond to Marcotte's (2019) letter to the editor, "The Influence of Treatment on Children's Recovery from Stuttering: Comments on Kefalianos et al. (2017) and Leech et al. (2017)," published by the Journal of Speech, Language, and Hearing Research.

PMID: 31058567 DOI: 10.1044/2019_JSLHR-S-17-0476

Self-acceptance, resilience, coping and satisfaction of life in people who stutter. - TERAPIA

J Fluency Disord. 2019 Mar;59:52-63. Epub 2018 Nov 1.

Plexico LW, Erath S2, Shores H, Burrus E.

Auburn University, United States.

PURPOSE: The purpose of the present study was to evaluate self-acceptance and satisfaction with life with people who stutter and the influence of coping and resilience on the two factors.

METHOD: Forty-seven people who stutter (PWS) and 47 people who do not stutter (PWNS) participated in an online survey. Participants completed a survey assessing 6 main areas: (a) background information, (b) satisfaction with life, (c) coping, (d) avoidance, (e) self-acceptance, and resilience.

RESULTS: Avoidant coping and maladaptive coping moderated the association between stuttering and self- acceptance but not satisfaction with life. Resilience was found to moderate the association between stuttering and self-acceptance as well as satisfaction with life.

CONCLUSION: Stuttering was associated with lower self-acceptance at higher levels of avoidant coping and maladaptive coping. PWS who have lower levels of resilience were more likely to have a lower satisfaction with life indicating that higher levels of resilience could serve as a protective factor for having a greater satisfaction with life. Further, stuttering was associated with lower self-acceptance at lower levels of resilient attitude. Resilience and coping appear to protect against having diminished self-acceptance and satisfaction with life for PWS.

PMID: 30446168 DOI: 10.1016/j.jfludis.2018.10.004

Self-efficacy beliefs: Experiences of adults who stutter - TERAPIA

J Fluency Disord. 2019 Jun;60:11-25. Epub 2019 Mar 29

Carter AK, Breen LJ, Beilby JM.

Curtin University, Western Australia, Australia.

PURPOSE: Childhood-onset stuttering is a complex and multifaceted disorder. Intervention for adults who stutter has historically addressed speech fluency more so than psychosocial aspects of the disorder, including the nature of the individual's self-efficacy beliefs concerning their confidence in their capacity to enact change. Self-efficacy is an important construct related to quality of life, resilience, and maintenance of treatment gains for adults who stutter. The purpose of this qualitative study is to explore the nature of the self-efficacy beliefs expressed by adults who stutter in order to inform efficacious and holistic intervention for these individuals.

METHOD: Semi-structured interviews were conducted with 29 adults who stutter to describe their experiences as a person who stutters and elucidate the nature of their self-efficacy beliefs.

RESULTS: Thematic analysis identified several major themes that provided novel insight into the complex nature of the self-efficacy beliefs experienced by adults who stutter: speaker experiences shaped communicative confidence, there was a conflict between communication and fluency, stuttering was viewed as more than fluency, and individual perspectives shaped communicative confidence, as did the pervading influence of self. The notion that fluency and confidence are inextricably linked was evident within and across each major theme.

CONCLUSION: These preliminary findings provide further support for a multidimensional approach to the treatment of adults who stutter. Findings will be used to inform a novel integrated fluency and psychosocial intervention for adults who stutter that addresses fluency and self-efficacy concurrently, with a view of engendering durable improvements in speech fluency and communicative confidence.

The assessment of the sensitivity of statistical methods has received little attention in cluster randomized trials (CRTs), especially for stratified CRT when the outcome of interest is continuous. We empirically examined the sensitivity of five methods for analyzing the continuous outcome from a stratified CRT - aimed to investigate the efficacy of the Classroom Communication Resource (CCR) compared to usual care to improve the peer attitude towards children who stutter among grade 7 students. Schools - the clusters, were divided into quintile based on their socio-political resources, and then stratified by quintile. The schools were then randomized to CCR and usual care groups in each stratum. The primary outcome was Stuttering Resource Outcomes Measure. Five methods, including the primary method, were used in this study to examine the effect of CCR. The individual-level methods were: (i) linear regression; (ii) mixed-effects method; (iii) GEE with exchangeable correlation structure (primary method of analysis). And the cluster-level methods were: (iv) cluster-level linear regression; and (v) meta-regression. These methods were also compared with or without adjustment for stratification. Ten schools were stratified by quintile, and then randomized to CCR (223 students) and usual care (231 students) groups. The direction of the estimated differences was same for all the methods except meta-regression. The widths of the 95% confidence intervals were narrower when adjusted for stratification. The overall conclusion from all the methods was similar but slightly differed in terms of effect estimate and widths of confidence intervals.

Although the underlying neural mechanisms remain unknown for both persistent developmental stuttering (PSD) and acquired neurogenic stuttering (ANS), few studies have examined similarities/differences between these two disorders. We evaluated in both PDS (n = 35) and ANS (n = 5) phonetic, word class, word length, and word position variables that are widely believed to influence at which loci within utterances PDS speakers' stuttering is most likely to occur. For both groups, (a) word weights based on the combination of variables were greater for stuttered vs. fluent words, and (b) stuttered words were loaded more by individual variables. However, contrary to long-standing views regarding PDS, greater loading for stuttered words was not found for the position variable. Findings suggest similar loci of stuttering in adults with PDS and ANS, and, for both groups, the probability of stuttering on a given word was more influenced by motor production variables than language variables.

BACKGROUND: The employment of clinical databases in the study of mental disorders is essential to the diagnosis and treatment of patients with mental illness. While text corpora obtain merely limited information of content, speech corpora capture tones, emotions, rhythms and many other signals beyond content. Hence, the design and development of speech corpora for patients with mental disorders is increasingly important.

AIM: This review aims to extract the existing speech corpora for mental disorders from online databases and peer-reviewed journals in order to demonstrate both achievements and challenges in this area.

METHODS: The review first covers publications or resources worldwide, and then leads to the reports from China, followed by a comparison between Chinese and non-Chinese regions.

RESULTS: Most of the speech databases were recorded in Europe or the United States by audio or video. Some were even supplemented by brain images and Event-Related Potential (ERP) statistics. The corpora were mostly developed for patients with neurocognitive disorders like stutter and aphasia, and mental illness like dementia, while other types of mental illness such as bipolar disorder, anxiety, depression and autism were scarce in number in database development.

STRENGTHS AND LIMITATIONS: The results demonstrated that database development of neurocognitive disorders in China is much scarcer than that in some European countries, but the existing databases pave an instructive road for psychiatric problems. Also, the methods and applications of databases from the leading countries are inspiring for Chinese scholars, who are searching methods for developing a comprehensive resource for clinical studies.

Persistent speech fluency disorders, mostly stuttering and less frequently cluttering, occur in approximately 1% of children and adolescents. They considerably impair the social participation and quality of life of those affected. The German interdisciplinary evidence-based S3 guidelines provide information about the pathogenesis, diagnostics and treatment of speech fluency disorders and contain a systematic review on the efficacy of stuttering treatment. For preschool children the Lidcombe therapy shows the best evidence of efficacy. Strong evidence also exists for an indirect approach. For adolescents and recently for children aged 6‑12 years old there is a high level of evidence for speech restructuring methods, such as fluency shaping. There is weak evidence for stuttering modification procedures and for combined speech restructuring and stuttering modification approaches. Negative evidence exists for the eclectic, unspecified stuttering therapies, breathing regulation, and hypnosis, which are frequently applied in Germany. An early start of treatment is decisive.

PMID: 31187151 DOI: 10.1007/s00106-019-0694-7

Stuttering and gray matter morphometry: A population-based neuroimaging study in young children - NEUROCIÊNCIAS

Erasmus University Medical Center, Rotterdam, the Netherlands; University of Michigan, Ann Arbor, MI, United States.

Stuttering is a developmental speech disorder originating in early childhood. We aimed to replicate the association of stuttering and structural morphometry using a large, population-based prospective cohort, the Generation R Study, and explore the neurobiological mechanism of stuttering in children. Twenty-six children with a history of stuttering and 489 fluent speaking peers (ages 6-9) were included in the MRI sub-study. Cortical and subcortical regions of interest were analyzed using linear regression models. Compared to fluent speakers, children with a history of stuttering had less gray matter volume in the left inferior frontal gyrus and supplementary motor area. Exploratory surface-based brain analysis showed thinner cortex in the left inferior frontal gyrus, and in bilateral frontal and parietal areas. These findings corroborate previous studies that reported aberrant brain morphometry in speech motor and auditory regions in children who stutter. Future research is needed to explore the causal nature of this association.

PMID: 31085031 DOI: 10.1016/j.bandl.2019.04.008

Stuttering as a matter of delay in neural activation: A combined TMS/EEG study - NEUROCIÊNCIAS

OBJECTIVE: Brain dynamics in developmental stuttering (DS) are not well understood. The supplementary motor area (SMA) plays a crucial role, since it communicates with regions related to planning/execution of movements, and with sub-cortical regions involved in paced/voluntary acts (such as speech). We used TMS combined with EEG to shed light on connections in DS, stimulating the SMA.

METHODS: TMS/EEG was recorded in adult DS and fluent speakers (FS), stimulating the SMA during rest. TMS-evoked potentials and source distribution were evaluated.

RESULTS: Compared to FS, stutterers showed lower activity of neural sources in early time windows: 66-82 ms in SMA, and 91-102 ms in the left inferior frontal cortex and left inferior parietal lobule. Stutterers, however, showed higher activations in later time windows (i.e. from 260-460 ms), in temporal/premotor regions of the right hemisphere.

CONCLUSIONS: These findings represent the functional counterpart to known white matter and cortico-basal-thalamo-cortical abnormalities in DS. They also explain how white matter abnormalities and cortico-basal-thalamo-cortical dysfunctions may be associated in DS. Finally, a mechanism is proposed in which compensatory activity of the non-dominant (right) hemisphere is recruited.

SIGNIFICANCE: DS may be a disorder of neural timing that appears to be delayed compared to FS; new mechanisms that support stuttering symptoms are inferred; the SMA may be a promising target for neuro-rehabilitation.

There is limited research concerning the nature of stuttering in balanced bilinguals. Hence, the aim of this study was to compare aspects of stuttering between two languages in balanced bilinguals who stutter (BWS). Eighteen adult Kannada-English BWS participated in the study, with Kannada as the first language (L1) and English as the second language (L2). As indicated by online language proficiency test results, all the participants were highly proficient balanced bilinguals. Audio-video recordings were done in both the languages across three tasks (reading, spontaneous speech, and telephonic conversation) and two situations (within the clinic and beyond clinic). They were analyzed for percentage of syllables stuttered (%SS) and perceptual severity rating scores (SEV). Results suggest significantly higher %SS in English compared to Kannada for both spontaneous speech (SS) and telephonic conversation (TC) tasks. SEV scores indicated significantly higher scores for English compared to Kannada for TC task. A significant positive correlation was also found across the %SS-SEV pair. Results highlight variability in the nature of stuttering in balanced BWS. Apart from the other factors, differences in the linguistic structure may be one of the reasons for differences in stuttering.

PURPOSE: Voluntary stuttering techniques involve persons who stutter purposefully interjecting disfluencies into their speech. Little research has been conducted on the impact of these techniques on the speech pattern of persons who stutter. The present study examined whether changes in the frequency of voluntary stuttering accompanied changes in stuttering frequency, articulation rate, speech naturalness, and speech effort.

METHOD: In total, 12 persons who stutter aged 16-34 years participated. Participants read four 300-syllable passages during a control condition, and three voluntary stuttering conditions that involved attempting to produce purposeful, tension-free repetitions of initial sounds or syllables of a word for two or more repetitions (i.e., bouncing). The three voluntary stuttering conditions included bouncing on 5%, 10%, and 15% of syllables read. Friedman tests and follow-up Wilcoxon signed ranks tests were conducted for the statistical analyses.

RESULTS: Stuttering frequency, articulation rate, and speech naturalness were significantly different between the voluntary stuttering conditions. Speech effort did not differ between the voluntary stuttering conditions. Stuttering frequency was significantly lower during the three voluntary stuttering conditions compared to the control condition, and speech effort was significantly lower during two of the three voluntary stuttering conditions compared to the control condition.

CONCLUSIONS: Due to changes in articulation rate across the voluntary stuttering conditions, it is difficult to conclude, as has been suggested previously, that voluntary stuttering is the reason for stuttering reductions found when using voluntary stuttering techniques. Additionally, future investigations should examine different types of voluntary stuttering over an extended period of time to determine their impact on stuttering frequency, speech rate, speech naturalness, and speech effort.

The University of Sydney, Australia; The University of Queensland, Australia.

PURPOSE: It is now well established that adults who present to speech clinics for help with stuttering will have an increased risk of having an anxiety disorder, particularly social anxiety disorder. Concomitant psychological problems are known to interfere with the maintenance of the benefits of behavioral speech treatments for stuttering. The current team has developed and trialed a cognitive behavior therapy (CBT) program designed specifically to reduce anxiety in adults who stutter, and trials have shown promise for both an in-clinic version and a standalone internet-based version. The aim of the present study is to determine whether iGlebe, the internet-based version of the team's internet CBT treatment (previously known as CBTPsych), enhances the benefits of behavioral stuttering treatment.

METHOD: Participants were 32 adults seeking treatment for stuttering. The design was a two-arm randomized experimental trial with blinded outcome assessments at 6 and 12 months post-randomization. Both arms received basic speech-restructuring training to reduce stuttering, without any anxiolytic (anxiety reducing) components. The experimental arm also received 5 months access to iGlebe.

RESULTS: There was evidence that, at 12 months post-randomization, iGlebe added clinically significant improvements to self-reported stuttering severity and quality of life. The present experimental trial provides the first evidence that the addition of CBT to speech restructuring improves speech outcomes.

CONCLUSIONS: The present results will be the basis for the development of a comprehensive, internet-based treatment program for anxiety associated with stuttering. Ultimately, it may be possible for such an economical, scalable, and translatable comprehensive treatment model to supplement standard speech-language pathology treatment practices for those who stutter.

PMID: 31100535 DOI: 10.1016/j.jcomdis.2019.04.003

Telepractice Treatment of Stuttering: A Systematic Review. - TERAPIA

Telemed J E Health. 2019 May;25(5):359-368. Epub 2018 Jul 31.

McGill M, Noureal N, Siegel J.

Portland State University, Portland, Oregon.

Purpose: The purpose of the current systematic review is to (1) guide and inform speech language pathologists involved in the treatment of persons who stutter in the development and implementation of live-stream, video telepractice services and (2) identify areas for future research related to telepractice and stuttering. Materials and Methods: Systematic searches of electronic databases, reference lists and journals identified seven studies that met predetermined inclusion criteria. These seven studies were analyzed and summarized in terms of the: (1) sample size, (2) characteristics of the participants, (3) technology and equipment utilized, (4) clinical setting, (5) treatment type, (6) research methodology, (7) results of the study, and (8) Oxford evidence-based practice levels. Results: Telepractice was used by university-based researchers and educators in the delivery of services to 80 participants who stutter. The services delivered included implementation of the Camperdown Program, the Lidcombe Program, and an integrated treatment approach. Conclusion: Live-stream, video telepractice appears to be a promising service- delivery method for treatment of stuttering using the Camperdown Program, Lidcombe Program, and integrated approaches. Further research is needed to determine if the initial evaluation and diagnosis of stuttering can be made using telepractice methodologies.

PMID: 30063187 DOI: 10.1089/tmj.2017.0319

The Efficacy of Phonological Processing Treatment on Stuttering Severity in Persian Pre-School Children - FALA

OBJECTIVES: Correct phonological encoding is crucial to fluent speech production. Phonological working memory and phonological awareness are important phonological processes that affect phonological encoding. The purpose of this study was to investigate the effect of phonological processing on stuttering severity of Persian pre-school children.

MATERIALS & METHODS: Six children were targeted in this study in Ahvaz City, southern Iran in 2018, with Quasi-experimental design (Before and after clinical trial). These children participated in a treatment protocol, scheduled in 13-sessions. The treatment protocol of the phonological processing included nonword repetition in the phonological working memory and phonological awareness therapy. Overall, 30 nonwords were taken to examine the phonological working memory. The Persian test of language development was taken to examine phonological awareness. Stuttering severity measurements were performed with pre- and post-treatment. The severity rating was instructed to the parents based on Guitar protocol. They were asked to keep score every day until the end of the treatment sessions, and they reported the score to the therapist.

RESULTS: The stuttering severity score in pre and post-treatment was significant (P=0.027), and in the follow-up, phase was not significant (P=0.236); stuttering severity was reduced in children who stutter. Moreover, the severity rating score reported by parents during treatment was significant (P= 0.0001). This showed a reduction in stuttering severity.

CONCLUSION: The poor performance of phonological awareness and phonological working memory in phonological processing affect stuttering severity. Treatment of sub-systems of phonological processing can have an important role in reducing stuttering severity and increasing speech fluency.

Purpose Two studies published recently in this journal sought to expand on previous attempts to explain and predict young children's recovery from stuttering. This letter addresses the influence of treatment on such research. Conclusions Recent publications from Kefalianos et al. (2017) and Leech, Bernstein Ratner, Brown, and Weber (2017) added to previous information that gender and language ability (or language growth) may be related to children's recovery from stuttering. The conclusions from both studies are difficult to interpret, however, because neither incorporated two factors known to influence children's recovery: a family history of recovery and, especially, the type and timing of treatment. Consideration of these two articles therefore raises multiple empirical, theoretical, and clinical issues that deserve to be fully addressed if our discipline is seeking to understand and to maximize recovery for young children who stutter.

PMID: 31058572 DOI: 10.1044/2019_JSLHR-S-17-0437

The lived experience of stuttering: a synthesis of qualitative studies with implications for rehabilitation - TERAPIA

PURPOSE: Stuttering is a chronic communication disorder resulting in challenging life experiences for many individuals. This review aimed to integrate qualitative findings on the lived experiences of people who stutter and identify implications for rehabilitation.

MATERIALS AND METHODS: A systematic literature search of electronic databases for studies published since 2000 was completed to identify research papers that used qualitative methods to explore the lived experiences of adults who stutter. Forty-five papers were read in full and a final seventeen papers were synthesised using a meta-ethnographic approach.

CONCLUSIONS: This review identifies the profound and predominantly negative impact that stuttering has on individuals' experiences. Avoidance is a commonly used strategy to manage stuttering with further negative consequences for the individual. To promote person-centred care and enhance treatment outcomes, clinicians should be cognizant of the profound impact of stuttering on the individual's life experience and incorporate targeted goals to reflect this when intervening.

IMPLICATIONS FOR REHABILITATION Clinicians should be aware of and understand the extent of the impact of stuttering on an individual's life which is typified by various forms of avoidance and challenges in a number of domains including employment, identity formation, relationship development and others' perceptions of the person who stutters. An impairment-based approach to stuttering treatment with adults focusing on the overt aspects of stuttering (i.e., speech behaviours) is not holistic and does not do justice to the spectrum of covert features such as avoidance, and internalised thoughts and feelings that are associated with the condition. Therefore, the adoption of a holistic approach to stuttering intervention is recommended. An understanding of adults' lived experience of stuttering has the potential to inform programme developments for children and adolescents with the same condition and thus employ preventative strategies to reduce the development of negative life experiences at an earlier age. Clinicians should engage with the field of disability studies to strengthen their practice and consider their role in addressing socially-imposed barriers such as negative attitudes impacting on people who stutter.

PMID: 30696288 DOI: 10.1080/09638288.2018.1555623

The working alliance in stuttering treatment: a neglected variable? - TERAPIA

BACKGROUND: Multiple factors can influence the working alliance and treatment outcome in speech and language therapy. The 'working alliance' is an important concept in treatment and can be described as the degree to which a treatment dyad is engaged in collaborative, purposive work. To date, relatively little attention has been paid to this concept within speech and language treatment in general, and within stuttering treatment research in particular.

AIMS: To investigate the role of the working alliance within stuttering treatment, and to evaluate whether the quality of the working alliance correlated with clients' concept of motivation and treatment outcomes 6 months post-therapy.

METHODS & PROCEDURES: Eighteen adults (21-61 years) participated in this multiple single-case treatment study, with treatment facilitated by an experienced speech and language therapist. The working alliance was investigated using the Working Alliance Inventory-Short Version Revised (WAI-SR), an Extended version of the Client Preferences for Stuttering Treatment (CPST-E), the Overall Assessment of Speakers' Experience of Stuttering-Adult version (OASES-A), the Wright & Ayre Stuttering Self-Rating Profile (WASSP) and the Hospital Anxiety and Depression Scale (HADS).

CONCLUSIONS & IMPLICATIONS: The working alliance between speech and language therapists and persons who stutter matters. Within the alliance, the level of client-clinician agreement on treatment goals and therapy tasks may be of greater importance than the bond between client and clinician. Further research with greater numbers of participants is warranted.

A prominent theory of developmental stuttering highlights (dys-)function of the basal ganglia (and in particular the ventral striatum) as a main neural mechanism behind this speech disorder. Although the theory is intriguing, studies on gray matter volume differences in the basal ganglia between people who stutter and control persons have reported heterogeneous findings, either showing more or less gray matter volume of the aforementioned brain structure across the brain's hemispheres. Moreover, some studies did not observe any differences at all. From today's perspective several of the earlier studies are rather underpowered and also used less powerful statistical approaches to investigate differences in brain structure between people who stutter and controls. Therefore, the present study contrasted a comparably larger sample of n = 36 people who stutter with n = 34 control persons and applied the state of the art DARTEL algorithm (Diffeomorphic Anatomical Registration Through Exponentiated Lie algebra) to analyze the available brain data. In the present data set stuttering was associated with higher gray matter volume of the right caudate and putamen region of the basal ganglia in patients. Our observation strongly supports a recent finding reporting a larger nucleus accumbens in the right hemisphere in people who stutter when compared to control persons. The present findings are discussed in the context of both compensatory effects of the brain and putative therapeutic effects due to treatment of stuttering.